While in the USA we are thinking licensing will insure payment by
insurance companies, we need to remember that not all licensed
providers are covered by
all insurance companies.  We also may want to consider that licensure
may further restrict the practice of IBCLC, limit the access to the
field by non medical professionals, and make it impossible for
volunteers to work as a licensed field of practice often limits the
work of others.  There is as much to lose by licensure as there is to
gain depending on the state you live in.  I have considered this for
years and changed my view often based on what I see happening in the
insurance industry and their refusal to pay for many services as well
as limiting coverage amounts, and determining how medical care will be
provided, etc.  I personally do not want to add the insurance industry
to the list of corporate controls over my work.

Some think insurance coverage will equate with Medicaid (government
paid health care) coverage for in need populations, which is what many
feel  necessary to bring services to under served populations. Perhaps
finding other ways to serve the mothers and babies who cannot afford
the care will be just as effective, and maybe more effective,
considering the level of care received by those who need it most.
Many already do this through grants, donations, volunteerism, WIC, and
other agencies providing services.  Yes, many fall through the cracks,
but I do not think licensure and reimbursement will prevent that
problem. I am open to changing my mind again, of course. I am sure
those looking into this issue have looked at every possible
ramification of the goal, not just the positive but the possible
negative outcomes to those in private practice on a state by state
basis.

I do however think some form of clinical experience standards would be
a nice idea.  The problem with that would be that we do not all
practice exactly the same way for every single moher and baby.
Lactation Consultant work is not a very 'task oriented' field where
you learn ABC and that is how it is always done.  Instead, you need to
be flexible, open to changing your practice methods, see each dyad as
unique and be willing to work accordingly.  Unlike how to run an IV or
give an injection or open heart surgery or setting a broken bone,
helping a mother breastfeed her baby is more than what you can learn
by doing the same thing over and over and over.  The truth is, what
works for one dyad may need adjusting for the next.  I can see the
benefit of some form of clinical supervision or at least mentorship,
but it would need to be more broad based than just one.  I learned
from many LCs and each one practiced differently and had different
ideas and ways of helping solve the same problem.  It taught me there
is no one answer that fits all situations.  I also learned that more
than one path arrived at the same goal.  Any future clinical
'training' should require multiple 'mentors' to be sure the "my way is
the only way" attitude stays out of the field of IBCLCs.

Take care,
Pam MazzellaDiBosco, IBCLC, RLC

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